Lab Test Plan An ‘Inducement’ For Nhi Buy-In

The Government’s push for doctors to conduct in-house laboratory testing was yesterday described as an “inducement” to entice the profession to sign-up to National Health Insurance’s (NHI) preferred care model.

Dr Duane Sands told Tribune Business that the Patient Centred Medical Home (PCMH) model contained “an option” for doctors to conduct clinical tests, such as blood and bodily fluid work, themselves rather than outsource this to a standalone laboratory.

This, he suggested, would provide doctors with a potentially lucrative additional revenue stream and bypass medical technologists in the laboratories - a move that might also allow the Government, via NHI, to cut healthcare costs.

Agreeing that this threatened to compromise healthcare quality, and reverse the sector’s previous direction, Dr Sands told Tribune Business: “If you look at the options in the Patient Centred Medical Home, one of them is to perform the lab work yourself, and thereby increase your revenue.

“Or you send it out to a different facility and be subject to whatever that lab charges. If you suggest there’s another profit centre in your office, where that supports the delivery of healthcare, you’re talking about a financial inducement for people [doctors] to become the cook, bottle washer and waiter.”

Dr Sands, backing the Bahamas Association of Medical Technologists’ (BAMT) concerns over this proposal, said the healthcare industry had “been down this road” before when doctors tried to act as pharmacists, despite not having any certified personnel in their offices.

“I have no problem in cutting costs, but what our patients are also looking for is quality care,” he told Tribune Business.

Dr Sands added that NHI’s seeming encouragement for doctors to acquire their own laboratory testing equipment also ran counter to the direction taken by previous administrations, “where it had become more difficult for physicians to do in-house lab studies”.

Technology and equipment have to be certified, and quality checks and assurances have to be provided, the FNM’s candidate for Elizabeth in the upcoming general election said.

“Now, with NHI saying that physicians can do these studies in their offices, it raises questions about the quality assurances, and validity and reliability of these lab results,” Dr Sands told Tribune Business.

Bonaventia Culmer, past president of the BAMT, told Tribune Business that the industry’s Monday meeting with the NHI Secretariat had provided some reassurance that the Government was not seeking to exclude the profession from its planned healthcare reforms.

She agreed that reducing healthcare costs under NHI, and enticing doctors to sign up for the scheme’s preferred care model, were both likely reasons why in-house laboratory testing by physicians had been encouraged.

“Some of them [doctors] were anxious and contacting us, and telling us this is what NHI has told them,” Ms Culmer told Tribune Business.

“We are hoping that they will desist from doing that. If a physician pops up and says this is what we want to do, let him go through the regulatory procedures and protocols, go through the standards and certification, and hire a licensed medical technologist to run the laboratory.

“Physicians are not focused on instruments and maintenance. That’s our focus. That’s why they can rely on us for that. The whole thing is about quality of care. Fast is good, but accuracy is more important.”

However, Ms Culmer said the Secretariat had informed them it was not pushing doctors to replace laboratories via in-house testing, and the BAMT would now contact the Hospital and Healthcare Facilities Licensing Board and Medical Association of the Bahamas (MAB) “to let them know out stance on it”.

Ms Culmer said the BAMT’s paramount concern was quality assurance, and that in-house testing by doctors adhered to recognised standards, with the tests conducted by a certified technologist.

She added that another “big concern” was how laboratories would be compensated for their work under NHI.

Ms Culmer said the BAMT wanted the present practice, where insurance companies directly pay medical laboratories for services rendered, to be maintained under NHI.

She explained that the sector was opposed to such payments being made to doctors, who would then pay the laboratories, as the former would likely retain a portion of that money for themselves.

In response, the NHI Secretariat told the BAMT members that the scheme would abide by existing practices for paying medical laboratories.

“They were very sharp, explained themselves well, and we take them at their word,” Ms Culmer said of the NHI Secretariat. “We may not get everything we ask for, but they will listen to our concerns and recommendations.

“The meeting was very productive in as much as we feel they’re working with us. We came out feeling reassured. We felt comfortable leaving the office. Let’s hope they continue with that.”

A Cabinet minister, meanwhile, has confirmed that the Government is likely to delay NHI implementation, with the April launch of the $100 million primary care phase set to be pushed back to an unknown date.

The comments from Dr Perry Gomez, minister of health, are unlikely to surprise many observers, given that both the Government and NHI are patently unready for a launch date that is just six weeks away.

The enabling NHI legislation is still undergoing changes, and has yet to be brought to Parliament, while there is still a lack of public and healthcare industry ‘buy in’ to the scheme. It is also suffering from too many unknowns and uncertainties, with key details yet to be resolved and finalised.